title: Comparison of techniques for double-lumen endobronchial intubation: 90° or 180° rotation during advancement through the glottis.
abstract: BACKGROUND
  During endobronchial intubation with a double-lumen endobronchial tube (DLT), the DLT is conventionally rotated through 90° when the bronchial tip is just past the vocal cords. This study was performed to investigate if rotation of the DLT through 180° decreases postoperative hoarseness, sore throat, or vocal cord injuries.
  
  
  METHODS
  Patients (n=164) undergoing thoracic surgery were randomized into two groups. Just after the bronchial tip passed the glottis, left-sided DLTs were rotated 90° (Group 90, n=84) or 180° (Group 180, n=80) counterclockwise and advanced. In the Group 180, DLTs were re-rotated 90° clockwise after the tracheal tip passed the glottis. Resistance during the advance of DLTs was assessed. Hoarseness and sore throat were evaluated for three postoperative days. Vocal cords were examined on the first postoperative day.
  
  
  RESULTS
  In nine patients allocated to Group 90, the DLT could not be advanced past the glottis because of severe resistance. There was less resistance to advancement of the DLT in Group 180 compared with Group 90 (P<0.001). The incidence of hoarseness was comparable between the two groups. Sore throat and vocal cord injuries occurred less frequently in Group 180 compared with Group 90 (20 vs 40%, P=0.008; 19 vs 47%, P=0.032).
  
  
  CONCLUSIONS
  Rotation of a DLT through 180° facilitated its passage through the glottis and reduced the incidence of postoperative sore throat and vocal cord injuries.
authors.affiliation: Department of Anaesthesiology and Pain Medicine and.
authors.forename: J-H
authors.initials: JH
authors.lastname: Seo
authors.forename: T-K
authors.initials: TK
authors.lastname: Kwon
authors.forename: Y
authors.initials: Y
authors.lastname: Jeon
authors.forename: D M
authors.initials: DM
authors.lastname: Hong
authors.forename: H J
authors.initials: HJ
authors.lastname: Kim
authors.forename: J-H
authors.initials: JH
authors.lastname: Bahk
mesh_terms: D000328:Adult; D000368:Aged; D058109:Airway Management; D016058:Analgesia, Patient-Controlled; D000769:Anesthesia, Inhalation; D005260:Female; D005336:Fiber Optic Technology; D005931:Glottis / Q000033:anatomy & histology; D006685:Hoarseness / Q000517:prevention & control; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000628:therapy; D010612:Pharyngitis / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D014827:Vocal Cords / Q000293:injuries; D055815:Young Adult
keywords: airway management; anatomy; anesthesia, general; intratracheal, intubation